The U.S. Supreme Court must take up a case that—if a lower-court ruling is allowed to stand—would set back preventive care in the United States and put millions of Americans’ health at risk, says an amicus brief filed by the AMA and 34 other physician, patient and provider groups.
This summer, the 5th U.S. Circuit Court of Appeals issued a ruling in Braidwood Management v. Becerra that jeopardizes a provision in the Affordable Care Act (ACA) requiring most insurers to fully cover the cost of preventive services recommended by the U.S. Preventive Services Task Force (USPSTF). It allows patients to access screenings for things such as breast cancer and colon cancer and take part in preventive services such as smoking cessation without out-of-pocket costs to them.
In the amicus brief, the Litigation Center of the American Medical Association and State Medical Societies and other organizations cited numerous studies that show that “the ACA’s preventive care mandate has saved lives.” They tell the court that the ACA “should continue to do so.”
The brief urges the court to hear the case and reverse the part of the lower court decision that says the USPSTF is unconstitutional. The lower court sided with plaintiffs that said that the president of the United States must nominate the task force members, and the U.S. Senate then must confirm those members, a procedure that hadn’t previously happened.
“The court of appeals’ decision threatens to erect formidable financial barriers to these life-saving services and reverse over a decade’s worth of progress in improving health outcomes,” the brief tells the court. Physicians “know from experience that patients will be less likely to obtain these services that will save lives if the preventive care mandate is stricken,” says the brief, noting that ultimately doctors “will see many of their patients and the individuals they serve turn down medically indicated services because of the very financial barriers that Congress sought to remove.”
The AMA Litigation Center has filed amicus briefs in Braidwood Management v. Becerra as the case has wound its way up and down the court system. For this brief, they joined forces with the American Cancer Society, American Academy of Family Physicians, American College of Obstetricians and Gynecologists, National Medical Association, National Hispanic Medical Association, The AIDS Institute and more than two dozen others.
Find out more about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.
Keeping the mandate matters
If the lower-court ruling stands and insurers and employers decide to require patients to share in the costs for preventive services or drop them altogether, millions of Americans could struggle financially to seek out the current, evidence-based preventive care services that the ACA requires their health insurance companies to cover.
In 2020, 151.6 million people with private insurance could access preventive services without cost sharing, according to the Office of the Assistant Secretary for Planning and Evaluation (ASPE). That’s up from the 137 million privately insured Americans who could do that in 2015 and ASPE attributes the increase to the ACA requiring the USPSTF recommendations be covered.
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The brief cites a number of studies that show those gains could be lost because patients would be less likely to receive preventive services if they had to share in the costs, including:
- A review of 65 papers published between 2000 and 2017 that showed that “even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services.”
- A 2023 survey showed that three out of 10 people delayed or skipped health care in the past year largely because of income constraints. At least half of those surveyed said that they wouldn’t pay out of pocket for preventive services such as tobacco cessation or for screenings for things such as HIV, depression and unhealthy drug use. More than a third said they wouldn’t pay for cancer screenings.
- Another recent study found 58% of cancer patients and survivors would be less likely to maintain preventive care, including recommended cancer screenings, if the coverage mandate is overturned and they ultimately had out of pocket costs for screenings.
Mandate saves costs, lives
The reason getting those screenings matters is because study after study has shown that early disease detection and preventive health care save lives, and it saves the health care system money.
The brief cites a study from the National Commission on Prevention Priorities estimating that boosting the use of five preventive services—including several backed by the USPSTF “would save more than 100,000 lives each year in the United States,” the brief says.
The brief lays out pages worth of studies that show how screenings and interventions save lives when it comes to the diseases they target, including breast cancer, colorectal cancer, cardiovascular disease, diabetes and smoking cessation.
“These studies confirm that access to preventive services, facilitated by insurance coverage, increases the likelihood that healthcare providers will diagnose conditions earlier than they otherwise could and that diseases can be prevented before they develop,” the brief says. “The data also illustrate that when providers diagnose conditions early, the likelihood of successfully treating patients and extending their lives increases.”
